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Living-Donor Allograft with Manual Grafting Technique for Extensive Pediatric Burns in Low-Resources Settings
A N Syarif1, B Pritasari2, H Putri2
1Division of Plastic Reconstructive and Aesthetic Surgery, Dr. Cipto Mangunkusumo Hospital, Head of Sub-Installation of Burn Unit Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Insights
Innovative surgical techniques, including the fold-and-cut method and living-related allografts, successfully treated a pediatric burn patient with severe complications in a resource-limited setting, demonstrating improved outcomes.
Area of Science:
- Plastic Surgery
- Pediatric Burn Management
- Regenerative Medicine
Background:
- Managing extensive pediatric burns is complex, especially with late presentation, systemic complications, and limited surgical resources.
- Delayed referrals increase risks of sepsis, coagulopathy, and metabolic disturbances, complicating treatment.
- Lack of essential equipment like dermatomes and meshers hinders optimal wound coverage in resource-limited settings.
Purpose of the Study:
- To present a case study of a pediatric burn patient with severe complications managed in a resource-limited environment.
- To evaluate the efficacy of the fold-and-cut technique for autograft expansion and living-related allografts for temporary coverage.
- To demonstrate adaptable and cost-effective solutions for improving burn care outcomes under constraints.
Main Methods:
- A 2-year-old female with 37.5% TBSA deep dermal to third-degree scald burns, referred 9 days post-injury with critical systemic complications.
- Serial excisional debridement and multiple skin grafting procedures were performed.
- The fold-and-cut technique was employed for autograft expansion (4.8-fold), and a living-related allograft was used as a temporary biological dressing.
Main Results:
- Successful integration of autografts and allograft led to complete epithelialization.
- Significant improvement in the patient's systemic condition, including stabilization of sepsis, thrombocytopenia, hypoalbuminemia, and D-dimer levels.
- Functional recovery observed, with the patient able to stand and attend school normally one year post-discharge.
Conclusions:
- The fold-and-cut technique and living-related allografts offer a feasible, cost-effective solution for pediatric burn management in resource-limited settings.
- Adaptation of surgical techniques and improvisation with available resources can yield favorable outcomes despite limitations.
- These methods can be adopted and modified by similar low-resource settings to enhance burn care where advanced technology is scarce.
Abstract:
Managing extensive pediatric burns is particularly challenging when patients present late with severe systemic complications and when surgical interventions face operational difficulties. Delayed referral increases the risk of sepsis, coagulopathy and metabolic disturbances, while limitations in essential equipment, such as dermatomes and mechanical meshers, further complicate treatment. Alternative techniques are needed to optimize wound coverage and improve outcomes in resource-limited settings. A 2-year-old female patient with 37.5% TBSA deep dermal to third-degree scald burns was referred nine days post-injury in critical condition with sepsis, thrombocytopenia, hypoalbuminemia and significantly elevated D-dimer levels. She underwent serial excisional debridement and multiple skin grafting procedures. Due to operational challenges in standard meshing, the fold-and-cut technique was used, allowing a 4.8-fold expansion of autologous grafts. A living-related allograft from her grandfather was applied as a temporary biological dressing to support epithelialization and reduce grafting needs. The autografts and allograft successfully integrated, leading to epithelialization, systemic stabilization, and functional recovery. At three months post-surgery, she had shown significant improvement, and one year post-discharge she could stand and attend school normally. This case highlights the ability to thrive despite limitations by adapting surgical techniques and leveraging available resources. The fold-and-cut technique and living-related allografts provided a feasible and cost-effective solution, proving that innovation and improvisation can yield favorable outcomes even in the most constrained environments. These findings demonstrate that similar low-resource settings can adopt and modify these techniques to improve burn care where access to advanced technology is limited.
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